Obesity-related focal and segmental glomerulosclerosis: normalization of proteinuria in an adolescent after bariatric surgery.
Obesity-related glomerulopathy (ORG) is a secondary form of focal and segmental glomerulosclerosis (FSGS) occurring in severely obese patients. A significant percentage of individuals with ORG will develop renal insufficiency or end stage renal disease. We report here a 17-year-old girl with morbid obesity (body mass index 56.8 kg/m(2)) and ORG presenting with nephrotic range proteinuria, who failed to improve following treatment with diet, exercise and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) therapy. Laparoscopic gastric bypass surgery was performed, and within 2 weeks following the surgery, the patient had lost 5.7 kg body weight and showed a remarkable decrease in protein excretion to one tenth of pre-surgery levels. More than 1 year after surgery, the patient's urine protein and kidney function have remained normal while off renin-angiotensin system inhibition therapy. This is the first report of successful use of gastric bypass surgery for obesity-related glomerulopathy in an adolescent. We propose that gastric bypass surgery be considered for patients with ORG.
Fowler
Susan M
SM
Division of Pediatric Nephrology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 11133 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9560, USA.
Kon
Valentina
V
Ma
Lijun
L
Richards
William O
WO
Fogo
Agnes B
AB
Hunley
Tracy E
TE
D002648:Child; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications* / Q000473:pathology / Q000652:urine; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications* / Q000473:pathology / Q000652:urine; D011507:Proteinuria / Q000601:surgery*; D016896:Treatment Outcome